Star Tribune Editorial

Star Tribune Editorial: Hope, profit/Proper oversight in health care

Reading the Star Tribune’s excellent series of articles on Parker Hughes Cancer Center can’t have been easy for a number of people, chief among them patients of the clinic and their families. For many other readers, the distress comes from a question the series raised: If these descriptions of medical practice run amok were accurate, where was the oversight, from both government agencies and private health-care insurers?

The answer is partly hopeful, mostly unsettling. Parker Hughes is a private enterprise operating in a highly competitive, even cutthroat, field controlled by a few players with lots of money for image advertising and for hiring batteries of lawyers. Moreover, regulatory control almost always occurs after the fact. A lawyer who knows that and who is determined to take advantage of it can get away with a great deal for a very long time. Unless employees or patients of a clinic complain persistently, nothing is likely to happen. Even if many do complain, getting to the truth can be a long, expensive and litigious undertaking. Every “i” must be dotted, every “t” crossed, every legal challenge anticipated. That’s an undertaking which until almost the very end operates out of public view, as is now happening.

Partly the confidentiality is explained by medical care being the issue. Society generally grants professionally licensed health-care professionals wide latitude in exercising their best judgment. If a physician operates on the wrong person or the wrong leg, that’s medical malpractice for which clear remedies are available. But questions about the appropriateness of care are far more difficult to resolve.

Because the community of Minnesota physicians operating in some specialties is small, questions about appropriate care are referred to experts from other states — to avoid bias and to blunt inevitable counteraccusations of vendettas motivated by professional jealousy or competition. That’s expensive and time-consuming. It’s also, by law, confidential. All the public generally learns is the outcome.

Concerns about medical business practices, such as billing improprieties and excessive charges, should be, and indeed sometimes are, raised when those who pay much of the bill — state health officials for Medicaid and private insurers such as Medica, HealthPartners and Blue Cross — review the charges submitted by clinics and physicians. More vigilant review of charges needs to become a matter of course.

When the Legislature convenes early next year, it should examine several issues raised by the Star Tribune series. Most seriously, it should assess whether more sunshine is needed when licensed Minnesota health professionals are accused of wrongdoing. If, for example, an expert evaluation validates a complaint, shouldn’t the public at the least have access to the evaluation — if only to assess any disciplinary action taken as a result? Right now, discipline is too much controlled by the professions themselves, and within the professions there exists a high tolerance for some misconduct, such as inflating credentials or seeking favors from vendors.

More broadly, the Star Tribune has illuminated one more reason why the United States should consider some form of a single-payer health care system. Americans generally get excellent health care. But the patchwork system by which they get it drains a hugely excessive amount of revenue from the economy — even as many millions of people go without any coverage at all.

At every level, escalating health-care costs compete with funding for teachers and schools, police agencies and road repair. In many households, those costs compete with the rent and the telephone. For a variety of complex reasons, normal market economics don’t work in health care. It’s one area in which government generally can do a more efficient job of controlling costs and ensuring good care for all.